UPSTATE NURSING REPORT

2015-2016 UPSTATE NURSING REPORT 2015-2016 UPSTATE NURSING REPORT i

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TABLE OF CONTENTS 3 Message from the CNO 4 About Us 6 Transformational Leadership 8 First in New York State 9 New Knowledge, Innovation and Improvement 14 Exemplary Professional Practice 19 Structural Empowerment 2015-2016 UPSTATE NURSING REPORT 1

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A MESSAGE FROM THE CHIEF NURSING OFFICER As the chief nursing officer for Upstate Nursing I have the distinct pleasure of leading a very diverse group. Our locations span acute/critical/emergency care at two regional hospitals as well as ambulatory services spread across a large part of central New York surrounding the Syracuse area. Diversity is expressed not only in the geographic locations where Upstate has a presence, but in our workforce s ethnicity, education, levels of practice, and scope of care for the patients we serve. Upstate Nursing is comprised of over 3000 staff caring for patients and families; 1582 of those employees are RNs. This inaugural annual report for Upstate Nursing will highlight the efforts undertaken to improve the quality of care for our patients and families, efforts to enhance the professional practice environment of our nursing staff and opportunities to provide career and professional growth for those members of our staff here at Upstate. The last two years have seen enormous growth for our institution, nursing in particular. Over 250 new positions have been added in nursing to accommodate for a growing patient volume and complexity of care. Investments in equipment that is critical to our bedside nurses roles have been made to bring state of the art technology to the bedside and improve the work flow for our staff. Tuition benefits have been enhanced to increase the number of bachelor s prepared RNs at the bedside, and also to encourage and facilitate all levels of nursing staff to take that next step in their education and career growth. The number of Upstate RNs certified in a specialty has grown by more than 30% in this recent year, a tribute to the dedication to learn more about chosen specialties and validate that knowledge through a national certifying exam. Upstate Nursing has set a goal for Magnet application submission by 2020. This level of recognition for excellence in nursing care is well earned by our Upstate Nurses efforts. Those efforts have brought to us numerous achievements: NICHE Exemplar recognition for care of the elderly; a significant decrease in hospital acquired pressure ulcers; a 5% increase in patient satisfaction scores with nursing communication. Nursing played an essential leadership role in DNV Comprehensive Stroke Center designation and the highest award thru the American Heart Association for care of patients with stroke. In addition Upstate Nurses hold lead roles in trauma accreditation, breast feeding initiatives, sepsis recognition, bay friendly accreditation, heart failure outreach, readmission prevention, safety initiative at Golisano Children s and improving transitions in care for so many of our patients. This is just to name a few. Upstate Nurses touch patients and family lives in so many impactful ways every day. An environment for learning is created by our nursing staff that is unmatched in this region as evidenced by the number of nursing programs that request clinical rotations across all our settings. Upstate Nursing is the academic difference for professional nursing practice in this region. Enjoy this publication and getting to know what Upstate Nursing is all about! Nancy E. Page, MS, RN, NEA-BC Chief Nursing Officer, Upstate Nursing 2015-2016 UPSTATE NURSING REPORT 3

ABOUT UPSTATE UNIVERSITY HOSPITAL Upstate University Hospital is the central New York region s only academic medical center. Upstate University Hospital has long held the distinction of caring for some of the most seriously ill and injured in the state and features the region s only children s hospital. Upstate University Hospital is a Designated Center for: Stroke, AIDS, Trauma, Burn, SAFE services, and Poison Control, and offers 77 unique specialty clinics. The Joslin Diabetes Program is a NYS Center of Excellence and our Epilepsy Center is a Level 4, the highest designation possible. Upstate s Community Campus rounds out the clinical care provided with the region s only geriatric emergency department and Pediatric After Hours/Urgent Care staffed by board certified physicians. In keeping with the Upstate vision to improve our communities health status Upstate is continuing to create and expand centers of excellence focused on cancer, breast care, cardiovascular care, behavioral medicine, ambulatory care, research and education. Upstate nursing and the entire interdisciplinary team will continue to provide comprehensive, seamless, and innovative patient and family centered health care to improve the health status of the communities served. VISION University Hospital s Vision Statement: University Hospital will provide comprehensive, seamless and innovative patient and family centered health care to improve the health status of the communities we serve. University Hospital will be the preferred area employer by offering an environment where employees and volunteers are personally and professionally valued, recognized, and supported. University Hospital will be a clinical center of educational and research excellence by continuously evaluating and adopting innovative practices in technology and health care. BY THE NUMBERS: 735 Licensed Inpatient Beds on two campuses 28,753 - number of admissions (2015) 96, 4111 - number of Emergency Department visits 224,000 - number of Ambulatory visits 77 hospital based specialty clinics 1.8 million - number of people served by Upstate University Hospital (2015) 3000 - number of employees - Nursing Department 1582 - number of RNs 673 - number of bedside RNs with a BSN or higher 330 - number of bedside RNs with specialty certification 15% - RN vacancy rate 83% Response Rate for the NDNQI RN Satisfaction Survey 2016 Upstate Nursing topped the aggregated overall response rate and average unit response rate for all 230 hospitals taking the NDNQI survey in October 2016 4 UPSTATE UNIVERSITY HOSPITAL NURSING

ABOUT UPSTATE MEDICAL UNIVERSITY MISSION The mission of SUNY Upstate Medical University is to improve the health of the communities we serve through education, biomedical research, and health care. VISION The vision for Upstate Medical University is to be the leading regional academic medical center in the nation. SUNY Upstate will be: A catalyst in the delivery of patient-centered health care that addresses our region s most pressing concerns; A highly-regarded resource for the education of health professionals, especially in shortage areas; A global resource for research that improves understanding of health and disease; A place to work that recognizes excellence. BY THE NUMBERS: 1 of 3 state universities affiliated with academic health centers 4 colleges - Medicine, Nursing, Health Professions, and Graduate Studies 1500 - number of students enrolled in one of Upstate Medical University s Colleges 298 nurses enrolled for Bachelor s, Master s, and Doctorate level nursing degrees VALUES We drive innovation and discovery by empowering our university family to bring forth new ideas and to ensure quality. We respect people by treating all with grace and dignity and embracing diversity. We serve our community by living our mission. We value integrity by being open and honest to build trust and teamwork. UPSTATE S DIVERSITY COMMITMENT: Consistent with our mission and values, Upstate strives to attract and cultivate diverse and culturally sensitive faculty, staff, and students. 2015-2016 UPSTATE NURSING REPORT 5

TRANSFORMATIONAL LEADERSHIP KEEPING NURSES AT THE BEDSIDE The growth of our institution can be appreciated from a distance by looking at the skyline of Syracuse, or experienced by walking through our halls. Getting around SUNY Upstate Medical University can be quite the journey. Our hospital staff certainly achieve daily goals of steps when caring for our patients. The question was raised How many of the steps made by nurses were directly contributing to patient care? When closely examined, nurses were found to spend time away from their patients looking for equipment or transporting patients for tests and procedures for far too many minutes/day. Upstate recognized an opportunity to improve and support our nurses professional practice environment. In April of 2015, a Patient Transport Team was created that assists in the transportation of patients throughout our hospital system. This team is easily identified with their purple scrubs and smiling faces. A request for services can be completed through our electronic medical record, EPIC. Since starting, the department has transported approximately 75,000 patients. On average the department assists with 250 transports a day, each of these transports averages 17 minutes. Todd Patnode the department manager summarizes this as 70 working hours a day that nurses are now on the floor instead of behind a wheelchair. Patients are transported safely and efficiently while keeping nurses at the bedside where our patients need them. One our nurses, Mary Teelin, RN, described the team as one of the best things that has happened for nursing and our patients. Prior to 2013, staff were experiencing delays in receiving equipment for patient care, and nursing was dissatisfied with the process of accessing the equipment needed. In early 2013, under the guide of Brian Reed a communication system to request, and track all equipment needs was implemented, appropriately called I GOT IT. Delivery times for items to nursing units went from 55 to 15 minutes. In June of 2013 this department was recognized by nursing staff with the Nursing Department Special Appreciation Award. This team has continued success in 2015, with being recognized nationally by the Mainspring Healthcare Solutions HOPE Award. This award goes to a model hospital, which has transformed their operations and delivers exceptional service to patients and nursing staff (Carney, 2015). This system has been replicated nationally at major medical universities in Boston, South Carolina and Washington D.C. In 2016, this department fulfilled over 90,000 requests and delivered more than 180,000 pieces of equipment. Our institution is proud to have pioneered this process, and been a leader to other hospital systems. The Transport Team and the Medical Equipment Request System have had major impacts on the care our nurses provide at Upstate. Thesystems are easy to use, and are quick to respond which improves both patient care and nursing satisfaction. Both of these process improvements have utilized technology to improve communication, and team work between departments at Upstate. Carney. A. (2015). SUNY Upstate University Hospital wins Mainspring HOPE Award. Retrieved from: http://www.prweb.com/releases/2015/07/prweb12857706.htm. 6 UPSTATE UNIVERSITY HOSPITAL NURSING

UPSTATE NURSES OBTAIN ADVANCED DEGREES THROUGH TUITION SUPPORT Upstate is well recognized for academic opportunities drawing in students from all over the world. Many of Upstate s 9000 employees enter Upstate in entry-level positions and utilize available tuition benefits, through their departments and our partner unions to advance their careers. Whether attaining initial licensed status or attaining advanced degrees, Upstate Nursing values this investment because of the rich contributions offered by those who have professionally grown and help further our mission to better serve our community. Whether the journey starts in a role as an environmental/ housekeeping employee to becoming a licensed registered professional nurse or a nursing assistant who becomes a nurse manager some day the power in the hundreds of personal success stories is measured in the positive changes that come to each individual employee and their family. The Department of Nursing is proud to support those career dreams. UPSTATE NURSING IS PROUD TO SUPPORT STAFF, WHO HAVE CHOSEN TO EMBRACE A CAREER IN NURSING WITH TUITION ASSISTANCE. 2015-2016 UPSTATE NURSING REPORT 7

FIRST IN NEW YORK STATE! UPSTATE UNIVERSITY HOSPITAL COMMUNITY CAMPUS FIRST IN STATE TO PERFORM ROBOTIC JOINT REPLACEMENTS WITH SPECIALIZED DEVICE Upstate Nursing played a key leadership role in achieving the DNV designation as a center of excellence for our Hip and Knee Replacement Program (HKRP). DNV GL Healthcare, a national hospital-accrediting agency, performed a rigorous onsite review on October 4, 2016. The designation demonstrates the quality of care provided by the orthopedic services located on the Community Campus, where the hip and knee replacement surgeries are performed. The collaboration of orthopedic surgeons, nursing staff, ambulatory clinic staff, and rehabilitation therapists has resulted in incredible growth of this service with volumes doubling since 2013. The HKRP offers patient access to the most innovative technology in our region. Upstate is one of the first hospitals to use to use the MAKO Robotic Arm Technology for total hip and total knee surgeries. This incredible innovation provides accurate, more precise positioning of a joint implant resulting in improved long term joint survival. In addition to surgical robotics, post-operatively patients receive continuous oxygenation, ventilation and ECG monitoring as needed with implementation of the Massimo Patient Safety Net and Phillips telemetry systems to maximize patient safety. Upstate Nursing is proud to offer patents enhanced recovery after surgery through innovation in preoperative preparation, preoperative patient education instructed by clinical nurses and rehabilitation therapists, enhanced pain control through regional blocks, and early post-operative mobilization. This passionate team of professionals is committed to continuous improvement and demonstrate the nursing values of professionalism, collaboration, education, resources, and holistic care. 8 UPSTATE UNIVERSITY HOSPITAL NURSING

NEW KNOWLEDGE, INNOVATION AND IMPROVEMENT NURSING INNOVATION AND ENTREPRENEUR SUMMIT: AN UPSTATE NURSING FIRST! Really a great conference! I wondered why my manager registered me for this, but I am so glad she did! These comments and more were expressed by nurses attending the first ever Nursing Innovation and Entrepreneur Summit held at the CNY Biotech Accelerator (CNYBAC) on November 30, 2016. Upstate Nursing Professional Practice & Innovation staff, Upstate College of Nursing faculty, and CNYBAC staff collaborated on the inaugural event to introduce nurses and other health care professionals to the many resources available to support innovation from creative idea to a medical device approved for clinical use. Following Chief Nursing Officer Nancy Page s welcome, CNYBAC s Theater-in-the-MIND provided the setting for attendees to explore how they might turn clinical problem solving into device development. During breaks, attendees were encouraged to identify challenges and solutions regarding innovation in CNYBAC s Creation Garage. Experts in intellectual property law, FDA Good Clinical Practice regulations, and innovation licensing provided more detail about the process of innovation, identifying local resources available to help future entrepreneurs. Sherod Harris, BSN, RN, ICU SWAT Nurse at Upstate and Trina Skeele, BSN, RN, Director of Patient Safety for Emergency Medicine Group at Upstate provided the highpoint of the event. President and Vice President, respectively, and co-founders of Harris Skeele Corp, Sherod and Trina shared their journey from identification of a clinical problem that could put patients at risk to invention of a device to resolves that problem. Not only have these two Upstate RNs invented one device, they have invented a suite of devices that have tested well and hold great promise for improving patient care. When asked what she would like to share about their journey, Trina replied, I will say that Sherod and I were able to bring our dream to light because we had each other to bounce ideas off of. We were honest about what we can do at certain times. We truly worked as a team, used each other s strength to get stuff done. Don t get me wrong we were very nervous about the whole thing, as we did not know what we did not know. So this journey certainly was an eye opener that there are so many layers to getting our invention to market as we are still on that journey. I have to say that it has made me feel that anything is possible if you stick to it and don t give up, you can always find a way to cross the finish line. We were also very realistic of what we are able to do... and we found out that we can do more than we thought was doable. Congratulations, Sherod and Trina!! 2015-2016 UPSTATE NURSING REPORT 9

NEW KNOWLEDGE, INNOVATION AND IMPROVEMENT USING TELEMEDICINE TO CONDUCT ENDOCRINOLOGY AND DIABETES CONSULTS FOR INPATIENTS AT THE COMMUNITY CAMPUS Advancements in technology have enabled health care professionals to conduct virtual visits with patients at distant sites. The health care industry refers to this development as telemedicine. Recently, a collaborative program has started involving nursing, endocrinologists from Upstate s Joslin Diabetes Center, and IT. This initiative provides inpatient tele-consults in Endocrinology and Diabetes to the Community campus, fulfilling a long-recognized clinical need since there are no endocrinologists working on the inpatient services of this campus. This effort is facilitated by Ms. Lori Gordon, RN, who serves as the Joslin diabetes educator at the Community Campus, and is guided by Dr. Marisa Desimone, Joslin Diabetes Center Telemedicine Medical Director. To conduct an Endocrinology/Diabetes in-patient consult, Lori brings the endocrinologist to the bedside of the inpatient at the Community Campus, utilizing mobile technology with video and audio capabilities, mounted on a cart. Lori receives communication from a Joslin Diabetes Center physician through Jabber application technology. Lori and the patient can visualize the physician and the physician can visualize them; both parties can also hear each other by audio. The endocrinologist also accesses the patient s medical record through EPIC. At the conclusion of the tele-visit, Lori (the nurse educator) provides the patient with any needed education and training. This team approach to care and use of new technology have expanded the delivery of real-time Endocrinology and Diabetes services to our in-patients at the Community Campus in order to provide state of the art quality of care. 10 UPSTATE UNIVERSITY HOSPITAL NURSING

THE REGION S ONLY PEDIATRIC EMERGENCY DEPARTMENT OPENED DOORS AUGUST 9, 2016 A multidisciplinary work group was established to participate in the design of a new 20 bed Pediatric Emergency Department dedicated to caring for children from birth through 19 years of age. Wish lists were generated, ideas researched, reviewed and debated. Direct care nursing staff and physicians were involved at the outset of the planning. Meetings initially happened once a month and then moved to weekly as the decisions and construction came closer. With the move to the new department came a large pediatric specific waiting room and an increase in beds from 13 to 24. When sick children and their families are brought to the Pediatric Emergency Department children see the walls of beautiful animal themes employing 3-D design by Tivolitoo, a company known for unique and creative designs. The Work Stations on Wheels used by staff for EPIC documentation are decorated as animals to distract the frightened patient. While a special firm hired to design the new unit, front line staff, including nurses, had a say in what was chosen. Child Life specialists guided the team as to what would be age appropriate for children 0-19 years and what would be calming and not scary. The treatment room where children may receive care during procedures is a private room with beautiful murals on the ceilings for distraction. A room was dedicated for any type of xray so the patient would not have to travel through the halls of the hospital to another location. With the new location and design came an area for pediatric Pharmacists and radiology technologists to work alongside physicians and nurses. Essential for a healthy work environment for staff is an adequate break room that allows the ability to access computers for education and space for staff to recharge during a busy shift. 2015-2016 UPSTATE NURSING REPORT 11

NEW KNOWLEDGE, INNOVATION AND IMPROVEMENT NEW DNP PROGRAM RECEIVES FULL ACCREDITATION STATUS BS, MS Degrees and Certificate Program Re-Accreditated In February 2015, the newly launched DNP program at Upstate s College of Nursing underwent its first accreditation compliance review. The evaluation team from the responsible accrediting body, the Commission on Collegiate Nursing Education (CCNE), made assessments of the College s DNP program regarding compliance with its Standards for Accreditation of Baccalaureate and Graduate Nursing Programs. The CCNE visit resulted in the College of Nursing receiving full accreditation status for the maximum five-year period, 2015-2020. The CCNE noted zero compliance concerns unusual in accreditation reports meaning the College exceeded standard achievement outcomes by a high margin. While visiting the campus in Syracuse, the evaluation team interviewed college and university officials, program faculty and students, alumni and community representatives. In addition, the team observed numerous online courses and a clinical activity. The entire College exemplified collaborative teamwork in documenting our work with doctoral students, commented former Dean Joyce GriffinSobel, PhD. Dr. Joyce Scarpinato, as the DNP program director and assistant dean for Graduate Studies, was particularly instrumental in achieving this outcome. I have been honored to lead such an exemplary group of faculty, staff and students and all are rightfully proud of this major accomplishment. The College of Nursing s bachelor s and master s degree programs also have been reaccredited and the postgraduate certificate program accredited by the Collegiate Nursing Education s Board of Commissioners through 2024. 12 UPSTATE UNIVERSITY HOSPITAL NURSING

NEW ACADEMIC BUILDING IS HOME TO COLLEGE OF NURSING For the first time in its more than half-century existence, Upstate College of Nursing has a new home Excitement grew as faculty, students and staff of the College of Nursing watched the completion of a new Academic Building on campus. The College moved from its Cedar Street location into the first floor of the new building west of Weiskotten Hall in the fall of 2016. The state-ofthe-art facility will transform the learning environment for Upstate nursing students. Team-based learning, distance learning and interprofessional education have come alive in classrooms rich with technology, and labs designed for the 21st century student. A multifunctional space on the fourth floor seats up to 349 people and is the largest gathering space on campus. Nursing students will be at the hub of the campus, with indoor accessibility from the CON to the Clinical Skills Lab, library and University Hospital, as well as to the parking garage. In addition, a convenient café will be on the same floor as the College at a future date. Being on campus will expand collaborations with the other colleges, which is essential to our work in interprofessional education, practice and research. We will have far more visibility as a College, both on campus and to the public, helping us communicate the critical part we play in improving the health of the Central New York community, commented Joyce Griffin Sobel, PhD, RN, CNE, ANEF, FAAN, former dean of the college. Bambi Carkey, DNP,PMHNP-BC, NPP (MS 00) joined the faculty in 1982 and has experienced several locations since then. It s exciting to give up our nomadic existence and come into a home of our own that s identified as the rightful space of the College of Nursing on the Upstate campus, she commented. 2015-2016 UPSTATE NURSING REPORT 13

EXEMPLARY PROFESSIONAL PRACTICE UPSTATE NURSING PROFESSIONAL PRACTICE MODEL Since 2009, Upstate Nursing has had a professional practice model developed by frontline clinical staff from all specialties. The model was implemented to align all nursing staff around our common values. Patient and family centered care is the central value of Upstate Nursing s professional practice model. Our nurses strive to strengthen practice so our patients, families, and the community we serve can achieve optimum outcomes. The values that drive Upstate Nursing s clinical practice include: Patient and Family Centered Care Collaboration Professionalism Holistic Care Resources Education Our nurses strive for every patient to experience patientcentered, safe, efficient, effective, high quality care the way every Upstate nurse would want our own family treated. 14 UPSTATE UNIVERSITY HOSPITAL NURSING

UPSTATE PARTICIPATES IN BQIH LEARNING COLLABORATIVE The NYS Breastfeeding Quality Improvement in Hospitals (BQIH) initiative is a joint initiative of the NYS Department of Health (DOH) and NICHQ (the National Institute for Children s Health Quality) to promote exclusive breastfeeding and to improve overall breastfeeding rates. In April 2016 Upstate University Hospital s application to participate in this learning collaborative was accepted. A multidisciplinary team of hospital personnel, a mother representative who delivered at Upstate Community Campus, and community partners including WIC and REACH, CNY were identified and agreed on the following: assess current hospital practices related to breastfeeding collect baseline data attend two in-person full-day meetings (travel support provided), two half-day meetings (via webinar), and 12 monthly one-hour conference calls; and monitor and report results on a monthly basis of 10 hospital practices that effect breastfeeding any breastfeeding attempted exclusive breastfeeding supplementation of breastfed infants breastfeeding within 1 hour for vaginal births breastfeeding within 2 hours for cesarean sections 1 hour of uninterrupted maternal-infant skin to skin contact (vaginal birth) 1 hour uninterrupted maternal-infant skin to skin contact (cesarean section) Maternal-Infant rooming in at least 23 out of 24 hours per day Infant feeding on cue Assessment of Breastfeeding The committee developed an AIM statement and 6 measurable goals to be completed by June, 2017. The team s primary goal that is expected to have the greatest impact on patient outcomes involves education of staff on breastfeeding basics, breastfeeding evaluation and documentation, and on staff support and breastfeeding education of patients. Education planned for the upcoming months includes bedside hands-on education, breastfeeding competency stations, and the addition of an 8-hour breastfeeding education class. Staff education combined with monthly Plan-Do-Study-Act intervention cycles has provided steady improvement in several outcome measures. Already our Family Birth Center at the Community Campus has exceeded all other institutions in this collaborative with infants rooming in with their moms, a key enabler to successful breastfeeding. 2015-2016 UPSTATE NURSING REPORT 15

EXEMPLARY PROFESSIONAL PRACTICE REGISTERED NURSE JOB SATISFACTION AT UPSTATE UNIVERSITY HOSPITAL Community Campus, including ambulatory locations Downtown Campus, including ambulatory locations PATIENT SATISFACTION WITH UPSTATE NURSING SYSTEM WIDE RESULTS 16 UPSTATE UNIVERSITY HOSPITAL NURSING

UPSTATE NURSING QUALITY Community Campus, minus ambulatory locations Downtown Campus, minus ambulatory locations 2015-2016 UPSTATE NURSING REPORT 17

EXEMPLARY PROFESSIONAL PRACTICE TRAUMA PROGRAM The adult trauma program had over 2,200 admissions in 2015 including 427 Level I trauma activations and 352 Level II activations. Trauma led 17 performance improvement projects in 2015 including I-Cough, ED Trauma Narrator Documentation Improvement Project, UHC Documentation Improvement with CDI, ED length of stay Lean Management Project and a trauma registry workflow process change. The trauma program has an educational mission hosting several courses for internal staff and the region including TCAR (Trauma Care After Resuscitation), AAAM AIS Course (Injury Scaling Course), TOPIC (Trauma Outcomes and Performance Improvement Course), in addition to holding ATLS (Advanced Trauma Life Support) monthly. The trauma program also has a presence in the region visiting our 28 referral hospitals and many of the ambulance agencies that transport trauma patients to Upstate. Additionally Upstate offers several injury prevention initiatives including the VEPOP (Violence Education Prevention Outreach Program), falls prevention in the elderly, bicycle helmet giveaways and our Let s Not Meet by Accident program for highschool students. Upstate Nurses hold leadership roles in the trauma programs both overall and our pediatric trauma program as well. NURSES IMPROVING CARE OF HEALTHSYSTEM ELDERS (NICHE) Nurses Improving Care of Healthsystem Elders (NICHE) is a nurse driven program to improve care of patients age 65 and over. It is Upstate Nursing s program goal to provide sensitive and exemplary care to the older adults we serve. Direct care staff throughout all of Upstate University Hospital entities have an important role in ensuring this goal is achieved. This year UH was designated as a NICHE Exemplar Hospital, the highest level of designation offered representing one of only 69 hospitals in the country designated at this level. Our program has attracted international attention with nurses from as far away as Singapore visiting Upstate to learn from our NICHE nurses and colleagues. In 2015 the UH goal was to promote the Geriatric Resource Nurse model on all adult inpatient units, and increase the number of Geriatric Resource Nurses (GRNs) across the organization. GRNs function on each unit as champions of best practice geriatric care. The number of GRNs at Upstate is now over one hundred growing from 23 in 2013. Examples of this engagement in care of the elderly from 2016 include: GRNS developed geriatric focused content and presented at Nursing Grand Rounds twice on the topics of Medication Safety and Nutritional Needs of Older Adults GRNs developed and presented geriatric introductory content to each cohort of Nurse Residency participants GRNs provided community outreach by presenting at the Onondaga County Office of the Aging Coalition on Preventing Falls and serving at the Nutrition and Health Expo for Seniors 18 UPSTATE UNIVERSITY HOSPITAL NURSING

STRUCTURAL EMPOWERMENT UPSTATE NURSING SHARED GOVERNANCE Upstate Nursing embraces shared governance as an opportunity to empower, engage, and support professionalism through a collaborative decision making process in which nursing staff participate in decisions that affect the clinical practice of nursing, standards of practice, and patient care. Our shared governance structure includes unit practice councils, specialty practice councils, and system councils. Our specialty councils, in which units with a common specialty meet to make practice decisions and policies that impact more than one unit, is a unique feature of Upstate s structure. Our system councils include Nursing Congress, Quality, Professional Development, Informatics, Best Practice Staffing, Nurse Manager Cabinet, and Research and Innovation. The shared governance structural schematic also visually contains the professional practice model at the center. Established in the 1990 s, our shared governance structure has been routinely redesigned by nursing staff to remain effective, relevant, and sustainable. A SOAR assessment was completed between August 4 September 22, 2015 to evaluate shared governance with results identifying opportunities for redesign. A redesign retreat was held on January 25, 2016 with 60 nursing staff from diverse specialties, roles, and settings with 458 collective years of experience gathered in one room. Recommendations were made for redesign of the professional practice model and the shared governance structure. Shared governance groups reviewed and approved redesign changes between February through April 2016. As redesign changes continue to be implemented, one of the hallmark changes during 2016 include transition of leadership from the Chief Nursing Officer to frontline clinical nurses of Nursing Congress, our system practice and coordinating council. All nursing department staff were able to participate in the nomination and election of Nursing Congress Co chairs. With assistance from shared governance coaches and support from managers, more than 20 new unit, specialty, or system councils were formed or relaunched by the end of 2016 with noted increase in RN perception of involvement in hospital affairs on the annual RN satisfaction survey. The current evolution of shared governance at Upstate seeks to establish sustainable structures, supported time for attendance, and a movement toward self-governance of professional practice. 2015-2016 UPSTATE NURSING REPORT 19

STRUCTURAL EMPOWERMENT CLINICAL ADVANCEMENT PROGRAM Upstate Nursing implemented the Clinical Advancement Program (CAP) in 2012 as a way to recognize and reward nurses for enhanced clinical and professional practice that leads to achieving optimal patient outcomes. CAP recognizes the various stages of learning nurses experience throughout professional career using Patricia Benner s theoretical framework of the Dreyfus Model of Skill Acquisition as it applies to the nursing profession (Benner, 1984). RNs can enter the program at three levels. Level 4, or competent RN, are an their beginning stages of engagement, and are becoming aware how their practice can influence to their units patient outcomes and goals. The level 5 RN, or proficient level, is starting to become active in initiatives that affect the patient outcomes and unit goals. While the Level 6, or expert RN, are those nurses that are the leaders of creating the initiatives which significantly affect patient outcomes and unit goals. Once a bedside RN has achieved CAP designation, they are allotted an allowance to use towards professional development activities. The money may be used towards attending conferences, purchasing text-books, professional nursing organization memberships, and continuing education. As noted in the graph involvement into the program is growing. The Professional Development System council, a group of frontline RNs focused on professional development, are looking to evolve the program to optimize its outcomes. SPECIALTY NURSING CERTIFICATION AT UPSTATE In addition to increasing BSN prepared frontline nursing staff, the Institute Of Medicine (IOM)also calls to increase the number of specialty certified bedside nursing staff (IOM, 2010). Research has shown in many studies that patient outcomes are significantly improved when cared for by certified nurses (Solomon, 2016). Upstate Nursing financially supports RNs to sit for the exam and recertification fees for nursing staff (Policy NDM B-29). Throughout each year more and more review courses are being offered on-site to staff to help prepare for their certification. Recently added was a component to our policy that allows reimbursement for online review courses. In the last year Upstate Nursing began an opportunity to recognize our certified nursing staff for going the extra mile by hosting certified nurses day celebrations. Our plan to increase certifications in the new year include offering diverse methods of review courses, to accommodate the various levels of adult learning as well as enroll in programs that offer second chance opportunities to ease any fear of failing the exam. References Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Solomon, D. (2016). Strategies to influence RN specialty certification. Nursing Management, 47(8), 38-46. doi:10.1097/01.numa.0000488858.54323.80 Policy Reference Upstate University Hospital Nursing Department Administrative Manual: Nursing Department Certification Program NDM B-29 References Benner, P. E. (1984). From novice to expert : excellence and power in clinical nursing practice. Menlo Park, Calif. : Addison-Wesley Pub. Co., Nursing Division, c1984. 20 UPSTATE UNIVERSITY HOSPITAL NURSING

BSN PREPARED NURSING PLAN & TUITION ASSISTANCE PROGRAM The most recent Institute of Medicine (IOM) report calls for bedside nursing staff who are bachelors prepared or higher for the future of the nursing profession (IOM, 2010). Upstate University Hospital recognizes the effects of having baccalaureate prepared RNs on quality patient care, this drives our tuition assistance program (TAP) that supports nursing staff to achieve higher education. For nursing staff who work part time, which is defined as 0.5-0.8 full time equivalents (FTE), up to a total of 15 credits is supported at the SUNY rate for each academic year. For our full time nursing staff, which is defined as greater than 0.81 FTE, up to a total 21 credits will be paid for at the SUNY rate for each academic year (Policy NDM B-25). In the last five years, Upstate University Hospital s Nursing s Department, tuition assistance program has paid well over 4.5 million dollars towards our nursing staff s continued education success. The tuition assistance program has not only allowed Upstate us to increase the percentage of our baccalaureate prepared bedside RN s, it allows our ancillary nursing staff to achieve their LPN and/ or RN degrees. In the academic years of 2015/ and 2016, approximately 9.3% of the total tuition dollars paid were towards our ancillary nursing staff s continuing education. A common phrase heard at new employee orientation to answer the question of why did you choose Upstate for employment, is educational opportunities. Upstate Nursing is committed to not only the educational success of our nursing staff, but for the increasing quality of care this is leads to for our patients. Reference Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Policy Reference Upstate University Hospital Nursing Department Administrative Manual: Nursing Department Tuition Assistance Program NDM B-25 2015-2016 UPSTATE NURSING REPORT 21

STRUCTURAL EMPOWERMENT CARDIOLOGY/HEART FAILURE PROGRAM/ HEART FAILURE CLINIC The Heart Failure Program s goal is to teach Heart Failure patients and their families how to better manage symptoms at home. Education regarding early symptom recognition can enhance quality of life, reduce the need for emergency department visits and reduce readmissions. When Heart Failure patients are admitted to either of our hospital campuses patients are seen by one of three Certified Heart Failure Nurses. Patients and families receive one on one education and their charts are reviewed to ensure that Guideline Directed Medical Therapies are being delivered. Patients who lack financial resources are provided with the tools needed to self manage care such as, scales, BP cuffs or cookbooks. The Heart Failure nurses work closely with the medical team, case managers and nursing staff to assist with a smooth transition to home or the next level of care. The Heart Failure nurses and the Upstate Cardiology Clinic staff have developed a rapport to effectively communicate changes that occur during the hospitalization, to ensure timely follow up and continuity of care. The ambulatory Upstate Cardiology clinic in conjunction with the in-patient Cardiology Services, Transitional Care and Emergency Departments has a mission to reduce hospital readmissions of patients due to Congestive Heart Failure (CHF). To accomplish this mission a CHF Clinic is being developed to be embedded within the ambulatory Cardiology Clinic. This care program will partner and further strengthen the integration between the care teams of the in and out patient care environments as they work together in a strategic evidenced-based manner to facilitate the bridging from in-patient to out-patient care while reducing overall hospital readmissions due to CHF. This endeavor will require excellent communication between both nursing environments. There is growing evidence demonstrating utilization of nursing personnel inclusionary of Advanced Practice Providers and RNs as part of the care team to bridge the gap between the two care environments. The program will include a Medical Director, Advanced Practice Providers, Registered Nurses and ancillary support. Working as a multidisciplinary team to facilitate continuity of care between inpatient and outpatient settings and offer timely evaluation for advanced heart failure therapies. In August of 2016 the Weigh Me Project began on 6A, 6B and 8F (Downtown) and 3West (Community Campus). The motivation for this quality project was for Heart Failure patients to be taught the importance of weighing themselves every day to monitor their fluid status.. Patients weigh themselves at home every day and call the weight to a nurse in the Cardiology Clinic when a weight gain is noted. This call results in diuretic adjustments or IV diuretic infusions in the Cardiology Clinic which can prevent a readmission to the hospital. The results of the pilot have been very positive. Orders for daily weights increased from 34% to 78%, daily weights obtained increased from 12% to 74%, and the type of scale used was documented 73.5% of the time. (Combined data both campuses). The Weigh Me Project is now being initiated on other units to continue improving quality of care for Upstate s patients. 22 UPSTATE UNIVERSITY HOSPITAL NURSING

COLLEGE OF NURSING GRADUATES FIRST DNP CLASS The first graduating class of Upstate Medical University s Doctor of Nursing Practice (DNP) program is a tremendous group of professionals now well prepared to launch into t expanded clinical roles encompassing populations and systems, as well as individual patients, according to program director Joyce Scarpinato, DNP, PNPBC, FNP-C 09. The four graduates completed their degree requirements in January (2016) and will walk for graduation at the University s Commencement ceremony in May. To celebrate,the College hosted a dinner with faculty to honor the new DNP alumni: Suzi Koshy, DNP, FNP-C; Denise Hiser Ruddick, DNP, FNP-C; Mashelle Jansen, DNP, FNP-C; and Ray Muldoon, DNP, PMHNP-BC. The College also brought on Koshy, Jansen and Hiser- Ruddick as adjunct clinical faculty for the FNP program. The College introduced the DNP program in 2013 as a part-time, online program that post-master s nurses can complete in two and a half years. This terminal degree provides the student with skills in translation and generation of evidence-based knowledge into clinical practice, as well as expanded skills in leadership, health policy and advocacy, interprofessional practice and information technology. In addition, a BS to DNP program will launch in 2017 and specialize in acute care, according to Scarpinato. Patients are far more complex than in the past, with multiple comorbidities. The knowledge and skills that nurses need to care for our populations are at the doctoral level, and at Upstate, we have the expertise to deliver that education, comments Scarpinato. DNP applications are accepted from September 1 through June 1. For more program information, see http://www.upstate. edu/ con/programs/dnp/. Please call Dr. Scarpinato at 315-464-3903 to discuss questions about your career progression.. 2015-2016 UPSTATE NURSING REPORT 23

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